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General NPI Number Information
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NPI Number | 1598941890
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Entity Type | Organization
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Legal Business Name | PUYALLUP VISION CENTER PS
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Dates
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Enumeration Date | 01/16/2008
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Last Update Date | 07/13/2010
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Provider Practice Location Address
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Address Line | 113 PIONEER WEST
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City | PUYALLUP
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State | WA
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Zip | 98371
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Country | US
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Telephone | 253-845-8215
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Fax |
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Provider Business Mailing Address
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Address Line | 113 PIONEER WEST
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City | PUYALLUP
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State | WA
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Zip | 98371
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Country | US
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Telephone | 253-845-8215
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | GARY D LINTON
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Credential | DO
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Telephone | 253-845-8215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OD00001704
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License Number State | WA
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